First 10 EM - August 3, 2015
"There really is not any good evidence for any of this. The St-Onge paper below concludes: “The evidence for treatment of CCB poisoning derives from a highly biased and heterogeneous literature… Based on the published literature, few valid inferences can be drawn about the relative merits of one intervention over another.” Considering the frustration this has caused me, this will probably have to be the subject of a long rant on the Research, Rants, and Ramblings section of this blog sometime soon.
I did not mention GI decontamination anywhere above. It is certainly a controversial subject, but neither side of the argument has great evidence to support them. This is a potentially deadly overdose without a great antidote, which should make it an ideal candidate for GI decontamination. However, there is no evidence that GI decontamination is beneficial, but there is plenty of evidence of harm. In a patient who is intubated and presented early, I would consider activated charcoal. With regards to whole bowel irrigation, I tend to agree with Leon Gussow (@poisonreview), who says that these patients can rapidly become hemodynamically unstable and the last thing that you want is to have a hypotensive patient not perfusing their gut full of polyethylene glycol. Rather than rushing to start anything, I would wait and listen to the advice of my local poison control center."
http://first10em.com/2015/08/03/calcium-channel-overdose/
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Gussow L - Emergency Medicine News. August 2015 (37); 8: 4
"Severe calcium channel blocker (CCB) overdose is still a diagnosis that strikes fear into the hearts of many emergency physicians. These patients can deteriorate rapidly, and every clinician who has seen even one such case appreciates the importance of diagnosing the exposure quickly and treating it aggressively. Successful management isn't difficult, however, as long as you keep these three pearls in mind when a patient presents to your emergency department after ingesting a CCB."
http://journals.lww.com/em-news/Fulltext/2015/08000/Toxicology_Rounds__Calcium_Channel_Blocker_ODs.7.aspx